Costs of Influenza Illness and Acute Respiratory Infections by Household Income Level: Catastrophic Health Expenditures and Implications for Health Equity

Wodniak N.Gharpure R.Feng L.Lai X.Fang H.Tian J.Zhang T.Zhao G.Salcedo-Mejía F.Alvis-Zakzuk N.Jara J.Dawood F.Emukule G.Ndegwa L.Sam I.C.Mend T.Jantsansengee B.Tempia S.Cohen C.Walaza S.Kittikraisak W.Riewpaiboon A.Lafond K.Mejia N.Davis W.Mahidol University2025-01-232025-01-232025-01-01Influenza and other Respiratory Viruses Vol.19 No.1 (2025)17502640https://repository.li.mahidol.ac.th/handle/20.500.14594/102827Background: Seasonal influenza illness and acute respiratory infections can impose a substantial economic burden in low- and middle-income countries (LMICs). We assessed the cost of influenza illness and acute respiratory infections across household income strata. Methods: We conducted a secondary analysis of data from a prior systematic review of costs of influenza and other respiratory illnesses in LMICs and contacted authors to obtain data on cost of illness (COI) for laboratory-confirmed influenza-like illness and acute respiratory infection. We calculated the COI by household income strata and calculated the out-of-pocket (OOP) cost as a proportion of household income. Results: We included 11 studies representing 11 LMICs. OOP expenses, as a proportion of annual household income, were highest among the lowest income quintile in 10 of 11 studies: in 4/4 studies among the general population, in 6/7 studies among children, 2/2 studies among older adults, and in the sole study for adults with chronic medical conditions. COI was generally higher for hospitalizations compared with outpatient illnesses; median OOP costs for hospitalizations exceeded 10% of annual household income among the general population and children in Kenya, as well as for older adults and adults with chronic medical conditions in China. Conclusions: The findings indicate that influenza and acute respiratory infections pose a considerable economic burden, particularly from hospitalizations, on the lowest income households in LMICs. Future evaluations could investigate specific drivers of COI in low-income household and identify interventions that may address these, including exploring household coping mechanisms. Cost-effectiveness analyses could incorporate health inequity analyses, in pursuit of health equity.MedicineCosts of Influenza Illness and Acute Respiratory Infections by Household Income Level: Catastrophic Health Expenditures and Implications for Health EquityArticleSCOPUS10.1111/irv.700592-s2.0-852143502191750265939789855